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Pulmonary Literature Review and Complex Case Prese ...
Complex Case Presentations PH.PE Steiger
Complex Case Presentations PH.PE Steiger
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Pdf Summary
This document provides a comprehensive review of pulmonary vascular disease, focusing on pulmonary hypertension and thromboembolic disease, emphasizing acute pulmonary embolism (PE) management. It presents complex case presentations from a professional medical session conducted by Dr. David J. Steiger, highlighting diagnostic strategies, risk stratification, and treatment options.<br /><br />Case summaries include the management of a 37-year-old male with suspected acute PE, showing unlabored respiration and concerning lab results leading to heparin administration. It stresses early discharge benefits versus hospitalization risks, leveraging guidelines for identifying low-risk patients using sPESI and Hestia scores.<br /><br />The document delves into the significance of subclinical right ventricular (RV) dysfunction even in low-risk PE cases and underscores the prognostic implications of elevated biomarkers like BNP and troponin. The importance of RV evaluation using current guidelines is discussed thoroughly.<br /><br />Another case highlights a 47-year-old female with acute symptoms and potential pulmonary hypertension (PH) detected through imaging and elevated biomarkers, managed through catheter-directed embolectomy.<br /><br />The discussion extends to prognostication models like PESI, sPESI, BOVA index, and the role of novel biomarkers and indices (e.g., neutrophil to lymphocyte ratio) in predicting mortality risk. The effects of normotensive shock are also examined, emphasizing the need for sophisticated risk stratification to determine appropriate interventions.<br /><br />Treatment strategies for intermediate and high-risk PE are examined, including systemic anticoagulation, thrombolysis, and catheter-directed approaches, evaluating their effectiveness and bleeding risks. Outcomes from various registries and studies, like the FLASH registry, underscore the efficacy of modern interventional strategies.<br /><br />For long-term management, the document discusses potential causes of persistent symptoms post-PE, chronic thromboembolic disease, and comprehensive management strategies, including multimodal approaches for chronic thromboembolic pulmonary hypertension (CTEPH), such as pharmacotherapy, balloon pulmonary angioplasty, and surgical options.<br /><br />This review underscores the necessity of multidisciplinary management and advanced therapeutics in pulmonary vascular diseases, offering a broad perspective on diagnosis, immediate care, and long-term patient outcomes.
Keywords
pulmonary vascular disease
pulmonary hypertension
PH
thromboembolic disease
acute pulmonary embolism
risk stratification
diagnostic strategies
treatment options
right ventricular dysfunction
prognostic biomarkers
multidisciplinary management
Pulmonary Hypertension
PH
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